Differential diagnosis of adnexal masses by combined sonography and color Doppler

Purpose: Color Doppler sonography is a non-invasive method which may improve the diagnostic accuracy of B-Mode sonography in ovarian tumors. Aim of the study was to evaluate the diagnostic sensitivity and specificity of B-Mode sonography and Doppler sonography as well as their combination in adnexal masses by multivariate analysis (multiple logistic regression). Method and Material: A total of 63 patients with adnexal masses were scanned preoperatively. In addition to the common sonographic criteria the parameters vascularisation, vessel distribution, blood flow velocities and impedance were investigated. By univariate analysis the significant parameters were determined. With the multiple logistic regression the independent factors were selected and ranked according to their diagnostic weight. Results: The histopathological results of the operatively resected tumors showed ovarian cancer in 22 patients and a benign tumor of the ovary in 41 patients. In the B-Mode sonography the detection of papillary structures or solid areas was shown to be the most valid criteria for malignancy. With this parameter alone we revealed a sensitivity of 95% and a specificity of 68%, corresponding to a 78% rate for accuracy. After multivariate analysis no other parameter of B-Mode sonography could improve these rates. For Doppler sonography the best discrimination between benign and malignant tumors could be seen with the criteria vascularisation and detection of central vessels, including the information solid areas of the B-Mode sonography. With this method a sensitivity of 86%, a specificity of 93%, and an accuracy of 90% resulted. In 57 out of 63 patients the preoperative diagnosis was correct. Blood flow velocities or impedance indices could not improve these results. With the parameters solid tumor area and vascularisation in solid areas the combination of B-Mode sonography and Doppler sonography showed the best rates for discrimination of benign and malignant adnexal masses. Conclusion: In the presented study color Doppler sonography could improve the diagnostic accuracy of B-mode sonography in adnexal tumors. Multivariate analysis of all significant parameters showed no improvement of the diagnostic impact by quantitative Doppler parameters compared to the qualitative detection of vascularisation in solid tumor areas.